Provider Demographics
NPI:1013583327
Name:SHUPE, NANCY SUE (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:SHUPE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SUE
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1187
Mailing Address - Country:US
Mailing Address - Phone:276-223-3200
Mailing Address - Fax:276-223-0617
Practice Address - Street 1:6999 CARROLLTON PIKE STE 2
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6341
Practice Address - Country:US
Practice Address - Phone:276-238-5600
Practice Address - Fax:276-238-1772
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional